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Year 4 Prescribing > Pain Relief > Flashcards

Pain Relief Flashcards

1
Q

What are the three classes of analgesics

A

Non opioid
Opioid
Adjuvant

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2
Q

Eg non opioid analgesics

A

Paracetamol

NSAID

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3
Q

Eg opioid analgesics

A

Codeine

Morphine

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4
Q

EG adjuvants

A

Antidepressants

Antiepileptics

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5
Q

What are the two main considerations for moderate pain

A

Codeine phosphate

Tramadol hydrochloride

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6
Q

What is good for pain relief of bone mets

A

Radiotherapy
Bisphosphonates
Radioactive isotopes of strontium chloride

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7
Q

Main things used for nerve pain

A

Gabapentin or pregabalin

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8
Q

Pain caused by nerve compression

A

Dexamethasone

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9
Q

What are the two types of preparations of morphine

A

Immediate release

Modified release

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10
Q

How often is immediate release morphine usually given orally

A

4 hourly

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11
Q

How often is modified release morphine usually given orally

A

12 hourly

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12
Q

How do you treat breakthrough pain

A

Immediate release morphine as a rescue dose

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13
Q

When should an additional dose of morphine be given

A

30 minutes before an activity that causes pain

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14
Q

How do you calculate the dose of the opioid for breakthrough pain

A

1/10 to 1/6 of the regular 24 hour dose repeated every 2-4 hours as required

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15
Q

When is a review of pain mgt needed

A

If needing more than 2 rescue doses for breakthrough pain

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16
Q

How do you increase morphine

A

Increments Should not exceed 1/3 to 1/2 of the total daily dose every 24 hours

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17
Q

What is the usual dose required for patients on morphine

A

IR 30mg 4 hourly
Or
MR 100mg 12 hourly

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18
Q

What is the maximum a patient may require for morphine

A

IR 200mg 4 hourly
Or
MR 600mg 12 hourly

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19
Q

How to start morphine

A

Give immediate release 4 hourly first then once pain controlled switch to equivalent dose of modified release 12-24 hourly

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20
Q

What should be prescribed routinely with morphine

A

Laxative

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21
Q

What are the main side effects of morphine that should be monitored for

A

Constipation nausea and vomiting

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22
Q

What is used if a patient cannot tolerate morphine

A

Oxycodone hydrochloride

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23
Q

Are codeine and tramadol equivalent doses

A

Yes

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24
Q

How to convert codeine or tramadol to morphine oral

A

Morphine is a tenth of the dose orally

25
Q

How to convert the oral morphine dose to IM IV or SC

A

Divide by 2 (half of the oral dose)

26
Q

How to convert morphine to oxycodone

A

Oxycodone dose is equivalent to 2/3 of the morphine dose

27
Q

How do you convert morphine to hydro morphone

A

Hydro morphine is a fifth of the dose of oral morphine

28
Q

How to convert codeine to dihydrocodeine

A

It’s equivalent!

29
Q

What are the two forms of morphine that can be given parenterallg

A

Morphine

Diamorphine

30
Q

How to convert oral morphine dose to the equivalent diamorphine dose to be given subcut

A

1/3 of the oral dose of morphine

31
Q

What pain relief can be given rectallu

A

Morphine

Oxycodone hydrochloride

32
Q

What are the main types of pain relief that can be given transdermally

A

Fentanyl

Buprenorphine

33
Q

If patients are on a transdermal patch what can be given for breakthrough pain

A

IR morphine

34
Q

What are the three formulations of transdermal patches

A

72 hourly
96 hourly
7 day patches

35
Q

How often are fentanyl patches on for

A

72 hours

36
Q

What three drugs are contraindicated for use in syringe drivers

A

Chlorpromazine hydrochloride
Prochlorperazine
Diazepam

As the cause local irritation
(Cyclizine and levomepromazine can also cause this)

37
Q

What is the usual infusion rate of a CSCI

A

0.1-0.3ml/hr

38
Q

What is the units of most pain reliefs

A

mg

39
Q

What type of morphine is given in a syringe driver and up to what max dose

A

Diamorphine (up to 250mg/ml)

40
Q

How do you give breakthrough pain relief in a patient with a syringe driver

A

Subcut or IM equivalent to 1/10 to 1/6 of the total 24 hour subcut infusion dose

41
Q

How do you minimise the risk of infection with syringe drivers

A

No subcut infusion solution should be used for longer than 24 hours

42
Q

What is the usual dose of the paracetamol

A

0.5-1g every 4-6 hours (max4g/ day)

43
Q

What is the dosage of paracetamol for people under 50kg o hepatotoxicity

A

15mg/kg every 4-6 hours

44
Q

What is the other indication for paracetamol

A

Pyrexia

45
Q

What are the two main cautions for paracetamol

A

Hepatotoxicity risk

Under 50kg

46
Q

When else should doses of paracetamol be reduced

A

With xoadministration of enzyme inducing anti epileptic meds in can increase risk of toxicity so doses should be reduced

47
Q

Paracetamol and EGFR less than 30

A

Make it 6 hours not 4

48
Q

What is the oral suspension of paracetamol

A

120mg/5ml
250mg/5ml
500mg/5ml

49
Q

What are the three preparations of cocodamol?

A

8/500
15/500
30/ 500

50
Q

What is the maximum doses of cocodamol per day?

A

64/4000
120/4000
240/4000

51
Q

What are the formulations of codeine

A

15mg 30mg 60mg

52
Q

What is the usual dose of codeine phosphate for pain

A

30-60mg every 4 hours (max 240mg per day)

53
Q

What drug should NOT be coprescribed with opioids

A

Benzos - can cause potentially fatal respiratory depression

54
Q

What are the main contraindications of opioids

A 
Acute resp depression 
Comatose patients 
Head injury 
Raised IcP 
Risk of paralytic ileus
55
Q

What are common side effects of opioids (MORPHINE)

A 
Miosis 
Out of it 
Resp depression 
Pruritus and pneumonia 
Hypotension and headache 
Infrequency (urinary retention and constipation) 
Nausea
Emesis

Also arrhythmias and palpitations

56
Q

Opioids in hepatic and renal impairment

A

Caution in hepatic impairment

Don’t use in renal impairment

57
Q

What is the typical dose of tramadol

A

50-100mg every 4-6 hours (maximum dose is 400mg /24 hours)

58
Q

What is the initial adult dose of morphine for acute pain

A

10mg every 4 hours

59
Q

What is the usual dose for chronic pain

A

5-10mg every 4 hours

Year 4 Prescribing (28 decks)

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